Individual
ANGELICA BUENROSTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
609 E ORANGEBURG AVE STE 201, MODESTO, CA 95350
(209) 572-3224
(209) 572-4528
Mailing address
609 E ORANGEBURG AVE STE 201, MODESTO, CA 95350-5512
(209) 572-3224
(209) 572-4528
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA18306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1068658
NCCPA CERTIFICATION
CA
01
—
PA18306
PA LICENSE
CA
Enumeration date
02/17/2006
Last updated
03/07/2023
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